Key result
Self-monitoring of blood pressure in pregnancy empowers patients but raises concerns over accuracy, anxiety, and workload.
Why the study?
There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of blood pressure in pregnancy, prompting exploration of staff perspectives on implementation challenges ahead of a trial.
What are the perspectives of maternity staff regarding the introduction of self-monitoring of blood pressure during pregnancy?
Observational (n=147)
Yes
What are the perspectives of maternity staff regarding the introduction of self-monitoring of blood pressure during pregnancy?
Introducing self-monitoring of blood pressure in pregnancy requires careful consideration of its impact on maternity services, patient agency, and clinical responsibilities.
Answers are grounded in this paper and cite their sources.
Staff concerns over accuracy, anxiety, and responsibility shifts warrant caution before routine adoption; leaves open net clinical impact pending trials.
OBJECTIVE: One in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial. DESIGN: Exploratory study using a qualitative approach. SETTING: Eight hospitals, English National Health Service. PARTICIPANTS: Obstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147). METHODS: Semi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken. RESULTS: The main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety. CONCLUSIONS: The potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women's health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women. TRIAL REGISTRATION NUMBER: NCT03334149.
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Hinton et al. (2020) conducted an observational in Hypertension in pregnancy (n=147). Self-monitoring of blood pressure (SMBP) vs. Routine clinical monitoring was evaluated on Perspectives and themes regarding the introduction and implementation of SMBP in maternity care. Maternity staff perceive that self-monitoring of blood pressure could enhance pregnant women's agency, but introduces significant challenges regarding device accuracy, patient anxiety, and shifting clinical responsibilities.
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